title: [Non-obstructive coronary artery disease documented by cardiac computed tomography: Discrepancy between atherosclerotic burden and cardiovascular risk].
abstract: Cardiac computed tomography (CT) documents the presence of coronary artery disease, regardless of the degree of stenosis. The prognostic value of non-obstructive coronary artery disease documented by cardiac CT has recently been validated. However, there are still no clear guidelines on the management of such patients, particularly concerning initiation of more aggressive pharmacological measures for primary prevention. The approach to these patients remains controversial, especially in cases in which there is a discrepancy between cardiovascular risk and the atherosclerotic burden as documented by cardiac CT. The authors describe the case of a patient with a discrepancy between the extent of documented coronary atherosclerosis and that estimated according to pretest probability and cardiovascular risk scores. As this individual had more severe coronary atherosclerosis than expected (calcium score above the 90th percentile and non-obstructive coronary artery disease on cardiac CT) but was a competitive athlete and otherwise asymptomatic and without risk factors or cardiovascular history, with a very low estimated cardiovascular risk, it was difficult to decide on the risks and benefits of pharmacological primary prevention.
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal. heldores@hotmail.com
authors.forename: Hélder
authors.initials: H
authors.lastname: Dores
authors.forename: Pedro
authors.initials: P
authors.lastname: de Araújo Gonçalves
authors.forename: Maria Salomé
authors.initials: MS
authors.lastname: Carvalho
authors.forename: Pedro Jerónimo
authors.initials: PJ
authors.lastname: Sousa
authors.forename: Hugo
authors.initials: H
authors.lastname: Marques
authors.forename: Nuno
authors.initials: N
authors.lastname: Cardim
authors.forename: Ana
authors.initials: A
authors.lastname: Aleixo
authors.forename: Miguel
authors.initials: M
authors.lastname: Mota Carmo
authors.forename: Francisco
authors.initials: F
authors.lastname: Pereira Machado
authors.forename: José
authors.initials: J
authors.lastname: Roquette
mesh_terms: D057791:Cardiac Imaging Techniques; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
keywords: Cardiac computed tomography; Doença coronária não obstrutiva; Exercício físico; Non-obstructive coronary artery disease; Physical exercise; Tomografia computorizada cardíaca